14-16 February 2017 Lilongwe, Malawi Mother – Baby Friendly Health Facility Initiative (MBFHI): Linking BFHI and MNH QI in Ghana Dr. Priscilla Wobil (Health Specialist-UNICEF)
14-16 February 2017 Lilongwe, Malawi
Mother – Baby Friendly Health Facility Initiative
(MBFHI): Linking BFHI and MNH QI in Ghana
Dr. Priscilla Wobil
(Health Specialist-UNICEF)
14-16 February 2017 Lilongwe, Malawi
• Background
• Country profile
• MNCH coverage and Quality gaps
• Improving maternal-newborn QoC and breastfeeding
outcomes – the Ghana approach (linkage with BFHI)
• Lessons learnt and areas that need strengthening
Outline
14-16 February 2017 Lilongwe, Malawi
Background – Country profile
• Population: 27 million
• Ten administrative regions
• National Health Insurance scheme
• 800,000 births yearly
Year 2015
• 926 institutional maternal deaths (DHIMS)
• MMR 319/100,000LB*
Year 2014
• NMR 29/1000LB (DHS 2014)
* WHO, UNICEF, UNFPA, World Bank Group, and the United
Nations Population Division. Trends in Maternal Mortality: 1990 to 2015. Geneva, World Health Organization, 2015
14-16 February 2017 Lilongwe, Malawi
Coverage and Quality gaps
Insurance scheme and free maternal-child healthcare services improved access and parental health seeking behaviour but not child health outcomes. Ansah et al, PLOS Med 2009; Bosomprah et al, APH 2015
• Yeji F et al (PLOS One 2015)
73%
87%
56%
0
10
20
30
40
50
60
70
80
90
100
Facility delivery(Access to services)
Breastfed within 24hrs (Utilisation ofservices)
Breastfed within 1hr (Effectivecoverage/Practice/Quality of service)
Early initiation of breastfeeding DHS 2014
14-16 February 2017 Lilongwe, Malawi
Improving MN QoC and breastfeeding outcomesThe Ghana approach - QUALITY IMPROVEMENT
1. Concept - MBFHI
Link and integrate maternal and newborn quality
improvement efforts (private-public health facilities, NHIA)
Revive, strengthen, and expand BFHI beyond
breastfeeding
Implement quality of care standards at every level of health facility that provides MNH services
• Safe
• Timely
• Effective
• Efficient
• Equitable
• People (family)-
centred
Linking BFHI and Quality maternal and newborn care
14-16 February 2017 Lilongwe, Malawi
• Quality improvement initiative being piloted in 3 countries with support from BMGF-UNICEF partnership EMEN QI model/WHO QoC framework
National Newborn Strategy and Action Plan (2014-2018)
• Baseline assessment findings Filling of partograph - only 37% of women
Immediate skin to skin contact – 64% of newborns
Early initiation of breastfeeding – 74% of newborns
PNC counselling before discharge from hospital was very low (3% - 16%) Breastfeeding (16%), FP (14%), maternal danger signs (6%) &
newborn danger signs (3%)
Birth companions were absent during PNC counselling 70% of the time
Improving MN QoC and breastfeeding outcomes: 2. Conduct assessment
14-16 February 2017 Lilongwe, Malawi
Improving MN QoC and breastfeeding outcomes:3. Development of the MBFHI guide & tools
Mother Baby Friendly Health Facility Initiative (MBFHI) Implementation Guide for Ghana
Linking BFHI and Quality maternal and newborn care
14-16 February 2017 Lilongwe, Malawi
MBFHI Standards (EMEN) WHO Quality of CareFramework
Linkage with BFHI -Ten
StepsStandard 1. Evidence-based safe care is provided during labour and childbirth. 1- Evidence based practices for
routine care and management of complications
BFHI Step 4
BFHI Step 1, 5, 6, 7, 8, 9
Standard 2. Evidence-based safe postnatal care provided for all mothers & newborns.
Standard 3: Human rights are observed and the experience of care is dignified and respectful for every woman and newborn.
4- Effective communication5- Respect and dignity6- Emotional support
Standard 4. A governance system is in place to support the provision of quality maternal and newborn care.
7- Competent and motivated human resources
8- Essential physical resources available
BFHI Step 2
Standard 5. The physical environment of the health facility is safe for providing maternal and newborn care.
Standard 6. Qualified and competent staff are available in adequate numbers to provide safe, consistent and quality maternal and newborn care.
Standard 7. Essential medications, supplies and functional equipment and diagnostic services consistently available for maternal-newborn care.
Standard 8. Health information systems are in place to manage patient clinical records and service data.
2- Actionable information systems
Standard 9. Services are available to ensure continuity of care for all pregnant women, mothers and newborns.
3- Functional referral systems
BFHI Step 10
14-16 February 2017 Lilongwe, Malawi
Improving MN QoC and breastfeeding outcomes:4. MBFHI Governance structure
. National MBFHI Steering Committee FHD
SecretariatRegional MBFHI
Committee
District MBFHI
Committee
District Hospital/Sub District
Health Facility Quality
Improvement Teams
Teaching Hospitals
QI Teams
Regional Hospitals Quality
Improvement Teams
Teaching Hospitals
MBFHI Committee
Technical Sub-
Committees
Breastfeeding
Sub- committee
Certification Sub-
committee
Intrapartum care
Sub-committee
Linking BFHI and Quality maternal and newborn care
14-16 February 2017 Lilongwe, Malawi
Improving MN QoC and breastfeeding outcomes4. Implementation
Studying
First phase single region implementation (learning process) in 4 districts
Baseline assessment (facility) – June 2016
Quality improvement - September 2016
Community assessment – September 2016
C4D activities (evidence-based) – November 2016
Quarterly monitoring, end-line evaluation –Sept 2018 (GHS/Navrongo Health Research Centre)
Modify document with lessons learnt after 1 year review
Cost-effectiveness assessment
Implementing and scale-up
Gradual scale-up to other districts and regions
Meeting with Research institution, UNICEF GCO, WCARO, NYHQ in Upper East Region - October 2016
14-16 February 2017 Lilongwe, Malawi
National MBFHI
Steering Committee
Integration of maternal and newborn QI into existing
BFHI
Decentralization of MBFHI
certification and implementation
Integration of MBFHI
standards into NHIA tools
Inclusion in pre-service education
Integration of MBFHI
standards into HFRA
standards
Linking MN QI and breastfeeding: Sustainability
14-16 February 2017 Lilongwe, Malawi
Lessons learnt
Data is key
Inclusiveness and buy-in
Building on existing
work and initiatives
Building local capacity
on QI
Strengthening needed
Coordination between
regional and national
level implementation
Improving MN QoC and breastfeeding outcomes
14-16 February 2017 Lilongwe, Malawi
Acknowledgement
International & National QI consultants Senior Managers - GHSHealth specialist
14-16 February 2017 Lilongwe, Malawi
Thank You
MBFHI coaches/facilitators